As we get older, our slowing metabolisms can make it harder and harder to stay thin. But the one thing that seems to get thinner without much effort is something we wish didn’t: our hair. Ironic, isn’t it? Lately, I’ve noticed long strands of my hair scattered around my bathroom. And I wonder if I’m losing more hair than normal or if it’s just standing out more because the floor in my bathroom is white. When I wash my hair, there’s lots of it in the drain.
It’s a bit disarming when that happens, but the reassuring news is that it’s normal to shed somewhere between 50 and 100 hairs a day. On days you wash your hair,that number can climb up to 250 strands lost. But what if there’s more shedding than that? You may find your hair sheds more a few months after a stressful event. It’s not uncommon to find you’re losing more hair about two months after giving birth. It can also occur after undergoing surgery, suffering severe emotional stress, losing 20 pounds or more or having an illness (especially if you’ve had a high fever).
That’s temporary. Eventually, your body readjusts and, along with that, the shedding slows and the hair on your head fills in, regaining its normal fullness. But real hair loss or female pattern baldness (the most common type of hair loss among women) is different. The evidence is much more apparent than some random strands falling out.
What happens with female pattern baldness is that over time the hair follicle shrinks and eventually stops growing new hair. The part in your hair may get wider or your ponytail may lose its bulk. Maybe there’s an unusually large amount of hair on your pillow when you wake. Or there’s a lot in the comb or brush, even though you brushed softly and without tugging. This type of hair loss usually begins in midlife but can begin earlier.
Why does it happen? Although the reasons are not well understood, it may be related to such things as aging, changes in hormone levels (specifically the male hormone androgen) or a family history of male or female pattern baldness. Diagnosis is usually based on your medical history, ruling out other causes of hair loss (like thyroid problems or recent surgery) and the actual appearance and pattern of the hair loss. Sadly, there’s no way to prevent it.
Unlike some men who embrace their bald heads, with the attitude that “bald is the new sexy,” hair loss in women is generally not welcomed kindly. Though it rarely progresses to total or near total baldness in women, it can be quite disconcerting and affect self-esteem. Although hair loss in female pattern baldness is permanent if not treated, it can be treated. You won’t regain the hair that you lost, but it’s possible for you to grow some new hair.
The only medication approved by the FDA to treat female pattern baldness is minoxidil (commonly known as Rogaine), which, like many drugs, was discovered by chance. Originally used to treat high blood pressure (in pill form), patients and health care providers noticed a side effect: hair growth. It may not restore the luster of yesteryear, but it can help.
An estimated 1 in 4 females will suffer with hair loss by the age of 35. For many, the cause is linked to sudden hormonal changes that follow puberty or precede menopause. For others, hair loss may occur as a result of high stress situations like divorce, pregnancy, or chronic illness. No matter what the cause, most women have trouble admitting that they are experiencing hair loss (i).
Two leading causes of female hair loss include Female Pattern Hair Loss (known by the medical name androgenetic alopecia) and Telogen Effluvium. Androgenetic alopecia causes hair loss at the top and sides of the head and may be seen at a variety of ages. Telogen Effluvium typically occurs during the latter years of life and, as the name suggests, happens when hair follicles enter into the telogen (resting) phase prematurely. This disrupts the natural hair growth cycle, causing visible signs of thinning, shedding, or balding.
What is female pattern hair loss?
Female pattern hair loss (FPHL) is a distinctive form of hair loss that occurs in women with androgenetic alopecia. Many women are affected by FPHL. In fact, around 40% of women by age 50 show signs of hair loss and less than 45% of women actually reach the age of 80 with a full head of hair.
In FPHL, there is diffuse thinning of hair on the scalp due to increased hair shedding or a reduction in hair volume, or both. It is normal to lose up to 50-100 hairs a day. Another condition called chronic telogen effluvium also presents with increased hair shedding and is often confused with FPHL. It is important to differentiate between these conditions as management for both conditions differ.
FPHL presents quite differently from the more easily recognizable male pattern baldness, which usually begins with a receding frontal hairline that progresses to a bald patch on top of the head. It is very uncommon for women to bald following the male pattern unless there is excessive production of androgens in the body.
What causes female pattern hair loss?
FPHL has a strong genetic predisposition. The mode of inheritance is polygenic, indicating that there are many genes that contribute to FPHL, and these genes could be inherited from either parent, or both. Genetic testing to assess risk of balding is currently not recommended, as it is unreliable.
Currently, it is not clear if androgens (male sex hormones) play a role in FPHL, although androgens have a clear role in male pattern baldness. The majority of women with FPHL have normal levels of androgens in their bloodstream. Due to this uncertain relationship, the term FPHL is preferred to ‘female androgenetic alopecia’.
The role of oestrogen is uncertain. FPHL is more common after the menopause suggesting oestrogens may be stimulatory for hair growth. But laboratory experiments have also suggested oestrogens may suppress hair growth.
What Causes Telogen Effluvium?
The most commonly documented causes of Telogen Effluvium include:
“There does indeed seem to be a link between stress, a change in hair follicle biochemistry, and more hair follicles entering a telogen resting state,” reports the American Hair Loss Association (iii). Several studies support this idea, demonstrating that high levels of stress may cause individual hair strands to prematurely enter the “telogen resting state” before eventually falling out. Examples of such stressors include ongoing chronic illness, divorce, or other significant life events in which the outcome is uncertain or feared.
Similarly to stress, abrupt episodes of physical trauma may also send hair follicles into a telogen resting phase. Examples include car accidents and other events that induce a forceful shock to the body.
Hair loss may be the side effect of certain medications like antidepressants (and other mood altering drugs), acne medications, and a variety of other prescription drugs. For a more comprehensive list, please reference this article on prescription drugs that cause hair loss.
Hair needs certain vitamins, minerals, and amino acids in order to grow naturally. For example, deficiencies in vitamin A, iron, or protein may inhibit the normal and healthy development of hair. Learn more about the foods for healthy hair, and proactively prevent hair loss due to nutritional deficiencies.
What is the normal hair growth cycle?
Everyone is born with a fixed number of hair follicles on the scalp that produce hairs throughout life. Hair grows from the base of the follicle at a rate of about one centimetre a month for about three years. This growth phase is called anagen. After anagen, the hair dies (catagen hair) and no longer grows. It sits dormant in the follicle for a three-month phase called telogen. After telogen, the hair follicle undergoes another anagen phase to produce a new hair that grows out of the same follicle. As it grows, the old telogen hair is dislodged or pushed out. This is a cycle that continues throughout life.
Increased hair shedding or telogen effluvium is a feature to FPHL. Women can use the hair shedding guide below to define whether hair shedding is normal or excessive,
To assess hair shedding, women should choose which of the 6 photographs of hair bundles best represents how much hair they shed on an average day.
Doctors can use the hair shedding scale to score hair loss at each patient visit to assess response to treatment. It can also be used in clinical trials to assess new treatments for excess hair shedding.
Unlike other areas of the body, hairs on the scalp to grow in tufts of 3–4. In androgenetic alopecia the tufts progressively lose hairs. Eventually when all the hairs in the tuft are gone, bald scalp appears between the hairs.
How long does it take for FPHL to progress?
FPHL can affect women in any age group but it occurs more commonly after menopause. The hair loss process is not constant and usually occurs in fits and bursts. It is not uncommon to have accelerated phases of hair loss for 3-6 months, followed by periods of stability lasting 6-18 months. Without medication, it tends to progress in severity over the next few decades of life.
What are the effects of female pattern hair loss?
Many studies have shown that hair loss is not merely a cosmetic issue, but it also causes significant psychological distress. Compared to unaffected women, those affected have a more negative body image and are less able to cope with daily functioning. Hair loss can be associated with low self-esteem, depression, introversion, and feelings of unattractiveness. It is especially hard to live in a society that places great value on youthful appearance and attractiveness.
Should I have any hormone tests done?
Blood tests include female and male sex hormone levels as well as thyroid function, as part of the diagnostic workup.
The majority of women affected by FPHL do not have underlying hormonal abnormalities. However a few women with FPHL are found to have excessive levels of androgens. These women tend also to suffer from acne, irregular menses and excessive facial and body hair. These symptoms are characteristic of polycystic ovarian syndrome (PCOS) although the majority of women with PCOS do not experience hair loss. Less often, congenital adrenal hyperplasia may be responsible.
What treatments are available?
Treatments are available for FPHL although there is no cure. It is important to manage expectations when seeking treatment, as the aim is to slow or stop the progression of hair loss rather than to promote hair regrowth. However, some women do experience hair regrowth with treatment. Results are variable and it is not possible to predict who may or may not benefit from treatment.
A Cochrane systematic review published in 2012 concluded that minoxidil solution was effective for FPHL. Minoxidil is available as 2% and 5% solutions; the stronger preparation is more likely to irritate and may cause undesirable hairgrowth unintentionally on areas other than the scalp.
Hormonal treatment, i.e. oral medications that block the effects of androgens (e.g. spironolactone, cyproterone, finasteride and flutamide) is also often tried.
A combination of low dose oral minoxidil (0.25 mg daily) and spironolactone (25 mg daily) has been shown to significantly improve hair growth, reduce shedding and improve hair density.
Once started, treatment needs to continue for at least six months before the benefits can be assessed, and it is important not to stop treatment without discussing it with your doctor first. Long term treatment is usually necessary to sustain the benefits.
Cosmetic camouflages include coloured hair sprays to cover thinning areas on the scalp, hair bulking fibre powder, and hair wigs. Hair transplantation for FPHL is becoming more popular although not everyone is suitable for this procedure.
Low level laser therapy is of unproven benefit in pattern balding but one device has been approved by the FDA for marketing. Further studies are required to determine the magnitude of the benefit, if any.
Where do I go to seek help?
Your first stop would be to see your general practitioner (GP) who can perform a medical workup to exclude other reasons for hair loss. Your GP can refer you to a dermatologist for further management of FPHL. Sometimes, it may be necessary for your doctor to perform a scalp biopsy to confirm this diagnosis.
It is important to seek reliable information and advice from authoritative sources as there are many bogus treatments that are expensive and do not work.
Like so many treatments, there are some caveats:
- It’s best to start at the first sign of hair loss.
- There may be a temporary increase in hair loss for the first two to eight weeks, which stops when your hair begins to regrow.
- It may irritate your scalp.
- You need to use it continuously for one year before knowing how well it will work for you. It may help hair growth in one in four or five women; in most women it may slow or stop hair loss.
- You must use it every day. If you stop, the hairs that grew during its use will fall out within three to four months.
If minoxidil doesn’t work, there are other medications approved by the FDA to treat other conditions but not female pattern hair loss that doctors may prescribe. Among them:
- Spironolactone (a diuretic)
- Birth control pills
The FDA has approved lasers, which emit a low level of laser light to treat hair loss at home. Available in the form of combs, helmets and other devices, they may help stimulate new hair growth and have been shown by some studies to be effective.
If you seek other nonmedical solutions which are often less expensive and the safest way to deal with the issue look into hair weaving, hairpieces or a change in your hairstyle to help hide the evidence. Other treatments being studied or used, but not proven effective, include:
Seek an Evaluation with a Team You Can Trust
If you suspect you are suffering with Female Pattern Hair Loss or Telogen Effluvium, you are not alone. Nearly 25% of all females experience signs of hair loss by age 35, and most cases are treatable. To learn more about the option that is best for you, schedule an appointment with the Hair Transplant Institute. Our team is comprised of South Florida’s finest hair transplant surgeons, nurses, microscopists, and technicians, each of whom understand the challenges hair loss presents to personal, social, and professional life.
For more information visit us our website: https://www.healthinfi.com0 200
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